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theme of justice to king lear BY 7227324 Listening Skills Questionnaire Date: Age: Client: Filled-out sy: Relationship / Title: Developmental and Environmental History (Please check if applicable) History of ear infections Delayed motor development Delayed speech or language development Emotional trauma, including dangerous or frightening experiences Exposure to loud sounds such as gunfire or loud concerts Ringing in one or both ears (which?

Concussion or head trauma Headaches This questionnaire is designed to provide information about the client’s auditory rocessing skills and the effect that they are having on language, communication, behavior, learning, and motor skills. Please respond to each of the following based on how this individual compares with others of similar age and background. Response Choices O: 2: 3: 4: Not a problem Sometimes Often Very often Ability to Understand What Other People Say 2 3 4 Needs to have information or instructions repeated Says, “Huh? or “What? ” Confuses similar sounding words Has difficulty understanding discussions Has difficulty following conversations Has difficulty remembering / following more than one r two directions Has trouble understanding humor / Jokes Listening Skills and Conditions; Auditory Memory Easily distractible when listening Short auditory attention span Oversensitive to certain sounds Tires easily 15192 central Ave. Chino, CA 91710 (909) 598-2482 Becomes sleepy when listening to speakers Feels that people talk too fast Gets confused in noisy situations Trouble with sound discrimination (phonemic awareness) Daydreams or tunes out in class Difficulty hearing and understanding in background noise such as TV, others talking, music, children laying, etc.

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Difficulty hearing and understanding in a quiet room (others may be present but are being quiet) Difficulty listening when there is also some other form of input (such as watching speaker’s face, a demonstration or illustration, listening to another read and reading along) Trouble immediately recalling spoken information Trouble recalling spoken information (such as instructions, word spelling, numbers, etc. ) when delayed recollection is required (1 hour or more) Trouble remembering order or sequence of spoken information Oral Communication Skills

Delay in speech or language development Has a slow or delayed response Monotone voice quality Speech lacks fluency and rhythm Difficulty with word retrieval (finding the words he/she wants to say) Uses “IJm” when speaking Uses vague language Confuses prepositional words such as “on” and “in” Poor grammar Difficulty organizing and expressing thoughts Tendency to ramble when retelling or explaining Uses few descriptive words Difficulty summarizing Difficulty reconstructing a story in appropriate order Difficulty giving a meaningful account of the events of the day

Difficulty speaking in front of the class or a group Difficulty getting started with open-ended questions Mispronounces words Loses his/her way in sentences or fails to finish longer sentences www. learningdisability. com Speaks mostly in phrases or single sentences. Does not elaborate Trouble articulating, or saying, certain sounds Avoids typical interactions with strangers in noisy environments (such as ordering at a fast food counter) Trouble talking on the phone Trouble rephrasing a point if he/she is not understood the first time Difficulty using humor Academic / School and Work Skills

Difficulty with phonics Difficulty with reading fluency Difficulty with reading comprehension Difficulty with spelling Can memorize words for spelling tests but cannot retain over time Difficulty remembering questions when called upon in class or meetings Difficulty with math concepts Difficulty with math calculations and math facts Difficulty with written expression Difficulty with writing mechanics (capitalization, punctuation, etc. ) Behavior and Social Skills Low frustration tolerance Poor self image or low self-esteem Difficulty making or keeping friends

Withdraws from or avoids social interactions Mood swings or moodiness Tendency towards irritability Tends to be anxious or tense Low motivation Difficulty getting started Difficulty completing tasks Poor planning and organization skills Difficulty with time concepts and punctuality Difficulty “reading” body language, facial expressions, and tone of voice. Tends to be forgetful Lacks tact Difficulty making Judgments and generalizing to new situations Energy Level Excessively tired at the end of the day Procrastinates Hyperactive Tendency towards depression

Trouble getting self going in the morning Very slow moving Motor Skills Poor balance or coordination Tends to be clumsy or awkward Excessive body movement when speaking Poor posture, including slouching and slumping Confusion with right and left Confusion about location and direction Poor sense of rhythm Poor handwriting Poor athletic skills Comparison of Scores (for office use only) Enter the total number of scores for each: O, 1, 2, 3, 4 # of O Scores # of 1 # of 4 Overall Average Score Not a problem Seldom Very Often (Numeric total divided by x 0=0 *Adjust if some items not answered

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